Provider Demographics
NPI:1700156528
Name:MAGILL, SHEA D (CRNA)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:D
Last Name:MAGILL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29211
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9211
Mailing Address - Country:US
Mailing Address - Phone:602-273-6770
Mailing Address - Fax:602-889-0483
Practice Address - Street 1:1900 N HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1604
Practice Address - Country:US
Practice Address - Phone:602-273-6770
Practice Address - Fax:602-889-0483
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN142961367500000X
AZCRNA0831367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ180649Medicare PIN